INTERNATIONAL STUDENT
CERTIFICATION OF FINANCES
2016–17
The purpose of the Certification of Finances is to help colleges and universities obtain complete and accurate information about the
funds available to international applicants who want to study in the United States. Strict government regulations, rising education costs
and economic conditions have made verifying the financial resources of international applicants essential. Institutions do not have the
option of deciding whether to verify the financial resources of their international applicants; financial verification must be made prior to
institutional issuance of a Certificate of Eligibility (Form I-20 or DS-2019).
This form is designed to standardize financial information provided by applicants to colleges, universities and U.S. consuls.
By completing this form and returning it to the college or university requiring it, an applicant, if admitted, may obtain that college’s
authorization and issuance of a Certificate of Eligibility (Form I-20 or DS-2019). If parents and/or sponsors are unable to obtain a bank
official’s verification, it is recommended that institutions forward a copy of the International Student Financial Aid Application to the
family for completion. The institution should attach a copy of this certification to the Certificate of Eligibility. U.S. consuls scrutinize the
statements of financial resources given by nonimmigrant visa applicants. This certification will help such officials make their decisions
and expedite visa issuance.
Return directly to the college providing or requesting this statement.
The space below is for optional use by issuing institutions for listing student's expected annual budget.
Academic Year 2016-2017
Full-time Tuition & fees*
Traditional Room and Board**
$18,780
$10,460
Additional Estimated Costs:
Books/Supplies
Personal Expenses
Mandatory Health Insurance
Total Additional Estimated Costs
$1,200
$2,000
$986
$3,950
Estimated annual budget
$33,426
OFFICE OF ADMISSION
441 Country Club Rd.
York, PA 17403
www.ycp.edu
[email protected]
*Other fees may be incurred including Undergraduate Differentials for Communications, Engineering, Nursing, and Respiratory Therapy majors.
**Room costs will vary depending upon which dormitory the student resides.
1. Your name
4. Date of Birth
O Mr. O Ms. O Mrs. O Miss
Month
Family (surname)
Given (first)
Middle
2. Permanent address
5. Place of Birth (country)
6. Country of citizenship
3. Mailing address (if different from above)
7. Expected Visa type
1
o
F-1
o
G-2
o
F-2
o
G-3
o
J-1
o
G- 4
o
J-2
o
H
o
G-1
o
Other (specify)
Day
Year
8. Enter the expected amount of annual support from the sources listed below. Enter amounts in U.S. dollars for each year of
support. Please PRINT all entries. Use an additional sheet of paper for explanations, if necessary.
Assured
Support
Student’s sources of funds
8a. Personal or family savings
Projected
Support
2017 -18
2016-17
$
.00
$
2018-19
.00
$
2019-20
.00
$
.00
Name of Bank
A bank official’s signature is required on the certification if the student is partially or totally supported by
personal savings. An official bank letter may also be accepted in lieu of signature below.
Date
Signature of Bank Official
Day
Month
Year
Title
Name of Bank
Address of Bank
Official certification of sources of funds and amounts
This is to certify that I have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
8b. Parents (Money available from sources other than savings.)
$
.00
$
.00 $
.00
$
.00
$
.00
$
.00 $
.00
$
.00
Father's Name
Mother's Name
Please describe the source:
Date
Signature of Parent
Day
Month
Year
Address
Official certification of sources of funds and amounts
This is to certify that I have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
8c. sponsors (Money available from sources other than parents.)
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
$
.00
Sponsor's Name
Sponsor's Name
Please describe the source:
Date
Signature of Sponsor
Day
Month
Year
Address
Relationship of Sponsor to Student
Official certification of sources of funds and amounts
This is to certify that I have read the information furnished by the applicant on this form, that it is a true and accurate statement, and that the funds are available and will be provided as indicated.
8d. Your Government
$
.00 $
.00
$
.00
$
.00
.00 $
.00
$
.00
$
.00
Name of Agency
Enclose an official signed copy of your letter of award with this form.
Total
$
2
9.
13. What is the total amount of money
you expect to have when
you arrive at this institution?
What is the present exchange rate of your country’s
currency to the U.S. dollar
(for example, 3,100 pesos = $1)?
$
.00
= $1
14. Do you plan to remain in the U.S. during the summer?
10. Does your government currently impose restrictions on exchange
and release of funds for study in the U.S.?
O
Yes
O
No
15. If remaining in the U.S., do you plan to attend
Summer school?
O Yes O No
If Yes, describe restrictions.
O
11. Do you have a source for emergency funds once you arrive
in the U.S.?
Yes
O
No
16. What are the sources and amounts of support
available to you during the summer?
O Yes O No
If Yes, name source.
Sources
Amount available in U.S. dollars
$
amount
.00
12. How will you pay for your transportation to the U.S.?
17
A CERTIFICATE OF ELIGIBILITY (Form
I-20 or ds-2019) will not be authorized
until this form is completed and
returned to the institution to which
you are applying. The institution will
attach a copy of this form to your
CERTIFICATE OF ELIGIBILITY . Both the
form and certificate must be shown to
the U.S. consul to obtain a visa.
U.S. $
.00
U.S. $
.00
U.S. $
.00
U.S. $
.00
Signature of Student
I certify that the information on this form is true, correct and complete.
I understand that any misrepresentation may be cause for refusing or
revoking admission.
Date
Day
Month
FOR OFFICE USE ONLY
This is to certify that I have reviewed the
declaration and attached documents, if
appropriate, and approve issuance of a
Certificate of Eligibility.
SIGNATURE OF
COLLEGE OFFICIAL
TITLE
NAME OF INSTITUTION
ADDRESS
DATE
3
Year